Classes
DEA Class; Rx
Common Brand Names; Zosyn
- Penicillins, Extended-Spectrum
Description
Extended-spectrum IV penicillin/beta-lactamase inhibitor combination antibiotic
Used for nosocomial and polymicrobial infections, including intra-abdominal, skin and soft-tissue, and lower respiratory tract infections
Combination does not have any more activity against P. aeruginosa than does piperacillin alone
Indications
Indicated for treatment of appendicitis (complicated by rupture or abscess) and peritonitis caused by beta-lactamase producing isolates of Escherichia coli or the following members of the Bacteroides fragilis group: B fragilis, B ovatus, B thetaiotaomicron, or B vulgatus
Indicated for treatment of nosocomial pneumonia (moderate to severe) caused by beta-lactamase producing isolates of Staphylococcus aureus and by piperacillin/tazobactam-susceptible Acinetobacter baumannii, Haemophilus influenzae, Klebsiella pneumoniae, and Pseudomonas aeruginosa
Indicated for treatment of uncomplicated and complicated skin and skin structure infections, including cellulitis, cutaneous abscesses and ischemic/diabetic foot infections caused by beta-lactamase producing isolates of Staphylococcus aureus
Indicated in treatment of postpartum endometritis or pelvic inflammatory disease caused by beta-lactamase producing isolates of E coli
Indicated for the treatment of community-acquired pneumonia (moderate severity only) caused by beta-lactamase producing isolates of H influenzae
Contraindications
Allergy to penicillins, cephalosporins, imipenem, beta-lactamase inhibitors
Adverse Effects
- Diarrhea (7-11%)
- Constipation (1-8%)
- Headache (1-8%)
- Insomnia (4-7%)
- Nausea (2-7%)
- Fever (2-5%)
- Oral candidiasis (2-4%)
- Rash (2-4%)
- Vomiting (2-4%)
- Dyspepsia (3%)
- Pruritus (3%)
- Pain (2-3%)
- Hypertension (2%)
- Leukopenia (1%)
- Thrombocytopenia (1.4%)
- Anaphylaxis
- Agranulocytosis
- Thrombocytopenia
- Eosinophilia, melena
- Leukopenia
- Positive Coombs test
- Prolonged PT and PTT
- Transient LFT and creatinine elevations
- Seizure
- Pulmonary edema
- Pulmonary embolism
Warnings
Risk of bleeding complications, especially in renal impairment; discontinue if thrombocytopenia or bleeding occurs
Leukopenia/neutropenia associated with prolonged therapy; periodic assessment of hematopoietic function should be performed, especially with prolonged therapy that is ≥ 21 days
Serious skin reactions reported, including Stevens-Johnson syndrome and toxic epidermal necrolysis, generalized exanthematous pustulosis; discontinue if reaction occurs
Monitor renal, hepatic, and especially hematopoietic functions during prolonged treatment
Prolonged use may result in fungal or bacterial superinfection
Administering drug in absence of a proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to the patient and increases risk of development of drug-resistant bacteria
Clostridium difficile associated diarrhea (CDAD) reported; if CDAD suspected or confirmed, may need to discontinue ongoing antibacterial drug use not directed against C. difficile; appropriate fluid and electrolyte management, protein supplementation may need to be implemented; antibacterial treatment of C. difficile, and surgical evaluation should be instituted as clinically indicated
Increased frequency of rash and fever reported in cyctic fibrosis patients receiving piperacillin
Risk of seizures may increase in patients with history of seizures when administered at higher than recommended doses given IV in the presence of renal impairment
Consider sodium content (2.79 mEq/g piperacillin) in patients requiring sodium restriction
Perform periodic electrolyte determinations in patients with low potassium reserves and who are receiving cytotoxic therapy or diuretics and consider possibility of hypokalemia in patients who have potentially low potassium reserves
Increased frequency of fever and rash reported in patients with cystic fibrosis receiving piperacillin
Pregnancy and Lactation
Piperacillin and tazobactam cross placenta in humans
Insufficient data available with piperacillin and/or tazobactam in pregnant women to inform a drug-associated risk for major birth defects and miscarriage
Piperacillin is excreted in human milk; tazobactam concentrations in human milk have not been studied
Maximum Dosage
18 g/day (16 g piperacillin and 2 g tazobactam) IV; however, doses up to 27 g/day (24 g piperacillin and 3 g tazobactam) IV have been used off-label for patients with cystic fibrosis.
18 g/day (16 g piperacillin and 2 g tazobactam) IV; however, doses up to 27 g/day (24 g piperacillin and 3 g tazobactam) IV have been used off-label for patients with cystic fibrosis.
weighing more than 40 kg: 18 g/day (16 g piperacillin and 2 g tazobactam) IV is FDA-approved dosage; however, doses up to 600 mg/kg/day piperacillin component (675 mg/kg/day piperacillin; tazobactam; Max: 27 g/day [24 g piperacillin and 3 g tazobactam]) IV have been used off-label for patients with cystic fibrosis.
weighing 40 kg or less: 400 mg/kg/day piperacillin component (450 mg/kg/day piperacillin; tazobactam) IV is FDA-approved dosage; however, doses up to 600 mg/kg/day piperacillin component (675 mg/kg/day piperacillin; tazobactam) IV have been used off-label for patients with cystic fibrosis.
weighing more than 40 kg: 18 g/day (16 g piperacillin and 2 g tazobactam) IV is FDA-approved dosage; however, doses up to 600 mg/kg/day piperacillin component (675 mg/kg/day piperacillin; tazobactam; Max: 27 g/day [24 g piperacillin and 3 g tazobactam]) IV have been used off-label for patients with cystic fibrosis.
weighing 40 kg or less: 400 mg/kg/day piperacillin component (450 mg/kg/day piperacillin; tazobactam) IV is FDA-approved dosage; however, doses up to 600 mg/kg/day piperacillin component (675 mg/kg/day piperacillin; tazobactam) IV have been used off-label for patients with cystic fibrosis.
10 to 11 months: 400 mg/kg/day piperacillin component (450 mg/kg/day piperacillin; tazobactam) IV is FDA-approved dosage; however, doses up to 600 mg/kg/day piperacillin component (675 mg/kg/day piperacillin; tazobactam) IV have been used off-label for patients with cystic fibrosis.
2 to 9 months: 320 mg/kg/day piperacillin component (360 mg/kg/day piperacillin; tazobactam) IV is FDA-approved dosage; however, doses up to 600 mg/kg/day piperacillin component (675 mg/kg/day piperacillin; tazobactam) IV have been used off-label for patients with cystic fibrosis.
1 month: Safety and efficacy have not been established; however, doses up to 320 mg/kg/day piperacillin component (360 mg/kg/day piperacillin; tazobactam) IV have been used off-label.
older than 30 weeks postmenstrual age: Safety and efficacy have not been established; however, doses up to 320 mg/kg/day piperacillin component (360 mg/kg/day piperacillin; tazobactam) IV have been used off-label.
30 weeks postmenstrual age and younger: Safety and efficacy have not been established; however, doses up to 300 mg/kg/day piperacillin component (337.5 mg/kg/day piperacillin; tazobactam) IV have been used off-label.
How supplied
Piperacillin/tazobactam
injection, lyophilized powder for reconstitution
- (2g/250mg)/vial: 2.25g
- (3g/375mg)/vial: 3.375g
- (4g/500mg)/vial: 4.5g
- (36g/4.5g)/vial: 40.5g
premix bag
- 2.25g/50mL
- 3.375g/50mL
- 4.5g/100mL